Surgery for Fuchs Dystrophy

 

Fuchs' dystrophy results in loss of corneal endothelial cells and the surgical treatment for this is the transplantation of healthy endothelial cells to replace the absent or diseased cells. The gold standard of corneal transplantation for Fuchs Dystrophy is an operation called DSAEK (Descemets stripping automated endothelial keratoplasty). Mr Angunawela is an expert in DSAEK surgery and spent one and a half years training with Professor Donald Tan in Singapore who is the inventor of the Tan Endoglide. The Endoglide is an advanced device for inserting a very thin layer of cells into the patient's eye and has been shown to cause the least amount of damage to the new endothelial cells during surgery. Mr Angunawela is also actively engaged in research that has led to significant improvement in the DSAEK surgical technique and our group at Moorfields was recently awarded the 'Best Paper' award by the American Academy of Ophthalmology and the 'Founders Gold Medal' for the presentation and publication of this work.

DSAEK surgery is a highly specialised and technically demanding surgical technique. Even in Europe, only 1 out of 4 corneal surgeons are able to perform this technique. In the recent past, patients with Fuchs' Dystrophy would need to have a full thickness corneal transplant (penetrating keratoplasty) leading to a long recovery period.

DSAEK surgery is a small incision technique with rapid visual recovery and no stitching of the transplanted tissue. As a result the eye after surgery is much stronger and vision recovers after just a few weeks. The risk of serious complications is also reduced compared with conventional transplantation and the risk of transplant rejection also appears to be lower.

 

DSAEK Endothelial Transplantation Surgery

DSAEK surgery is performed through very small incision that allow the surgeon to gently introduce a thin layer of donor corneal tissue with healthy endothelial cells into the front compartment of the patient's eye. Mr Angunawela uses the Tan Endoglide to do this as this device has been shown to cause the least damage to the donor tissue at the time of insertion. This layer of tissue is specially prepared and is only one tenth of a millimetre thick. 

Once the new endothelial cell layer is within the eye it is gently floated upwards until it makes contact with the back surface of the patients cornea. The air pressure is then increased so that the graft is pressed into position. No stitches are used to hold the graft in position. Some air is left in the eye at the end of surgery and the patient is asked to lie flat for at least a hour after surgery so that the air bubble continues to press the new layer of cornea into position.

Surgery can be performed under local or general anaesthesia.

DSAEK and cataract surgery

As Fuchs dystrophy commonly occurs as patients enter their fifties and sixties some cataract is often present. Conversely Fuchs Dystrophy is often accelerated by cataract and other types of surgery that can lead to earlier corneal failure. 

If there is cataract present at the time that DSAEK surgery is required, then cataract surgery and DSAEK can be combined in the same operation. Mr Angunawela prefers this approach as it means that only one surgery and anaesthetic is required. Mr Angunawela will discuss the best option for you.


Mr Angunawela teaches  DSAEK on the highly successful 'Advanced DSAEK surgery' together with Professor Tan at the annual European Corneal Society meeting.